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Wu W, Gao M, Wu X. A Systematic Review and Meta-Analysis of Influences of Chronic Kidney Disease on Patients after Percutaneous Coronary Intervention for Chronic Total Occlusions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:9450752. [PMID: 36873791 PMCID: PMC9977539 DOI: 10.1155/2023/9450752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 02/24/2023]
Abstract
Objective Chronic kidney disease (CKD) is a clinical collective term for kidney disease with glomerular filtration rate (GFR) < 60 mL/min for more than three months due to various factors and is usually associated with coronary heart disease and is also an independent risk factor for coronary heart disease. This study is aimed at systematically reviewing the influence of CKD on the outcomes of patients after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). Methods The Cochrane Library, PubMed, Embase, China biomedical literature database (SinoMed), China National Knowledge Infrastructure, and Wanfang database were searched for case-control studies on the influence of CKD on outcomes after PCI for CTOs. After screening the literature, extracting data, and evaluating the quality of literature, RevMan 5.3 software was used for meta-analysis. Results There were 11 articles with a total of 558,440 patients included. Meta-analysis results indicated that left ventricular ejection fraction (LVEF) level, diabetes, smoking, hypertension, coronary artery bypass grafting, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), β-blockers, age, and renal insufficiency were the factors affecting outcomes after PCI for CTOs [risk ratio and 95% confidence interval were: 0.88 (0.86, 0.90), 0.96 (0.95, 0.96), 0.76 (0.59, 0.98), 1.39 (0.89, 2.16), 0.73 (0.38, 1.40), 0.24 (0.02, 3.9), 0.78 (0.77, 0.79), 0.81 (0.80, 0.82), and 1.50 (0.47, 4.79)]. Conclusion LVEF level, diabetes, smoking, hypertension, coronary artery bypass grafting, ACEI/ARB, β-blockers, age, renal insufficiency, etc. are important risk factors for outcomes after PCI for CTOs. Controlling these risk factors is of great significance for the prevention, treatment, and prognosis of CKD.
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Affiliation(s)
- Weifei Wu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, Zhejiang 313000, China
| | - Menghan Gao
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, Zhejiang 313000, China
| | - Xu Wu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, Zhejiang 313000, China
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Zhao S, Chen Y, Zhu B, Wang J, Wei Z, Zou Y, Hu W, Chen G, Wang H, Xia C, Yu T, Han P, Yang L, Wang W, Zhai Z, Gao H, Li C, Lian K. Percutaneous coronary intervention improves quality of life of patients with chronic total occlusion and low estimated glomerular filtration rate. Front Cardiovasc Med 2022; 9:1019688. [PMID: 36620621 PMCID: PMC9812571 DOI: 10.3389/fcvm.2022.1019688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background A low estimated glomerular filtration rate (eGFR <90 mL/min/1.73 m2) is widely recognized as a risk factor for major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, the impact of successful CTO-PCI on quality of life (QOL) of patients with low eGFR remains unknown. Objectives The aim of this prospective study was to assess the QOL of CTO patients with low eGFR after successful PCI. Methods Consecutive patients undergoing elective CTO-PCI were prospectively enrolled and subdivided into four groups: eGFR ≥90 mL/min/1.73 m2 (n = 410), 90 > eGFR ≥ 60 mL/min/1.73 m2 (n = 482), 60 > eGFR ≥ 30 mL/min/1.73 m2 (n = 161), and eGFR <30 mL/min/1.73 m2 (n = 23). The primary outcomes included QOL, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire, and symptoms, as assessed with the Rose Dyspnea Scale (RDS) and Seattle Angina Questionnaire (SAQ), at 1 month and 1 year after successful PCI. Results With the decline of eGFR, CTO patients were more likely to present with comorbidities of hypertension, diabetes, hyperuricemia, and previous stroke, in addition to lower hemoglobin levels and left ventricular ejection fraction (p < 0.05). Low eGFR was associated with greater incidences of in-hospital pericardiocentesis, major bleeding, acute renal failure, and subcutaneous hematoma, but not in-hospital MACE (p < 0.05). Symptoms of dyspnea and angina were alleviated in all CTO patients with eGFR ≥30 mL/min/1.73 m2 at 1 month and 1 year after successful CTO-PCI, but only at 1 month for those with eGFR <30 mL/min/1.73 m2 (p < 0.01). Importantly, QOL was markedly improved at 1 month and 1 year after successful PCI (p < 0.01), notably at a similar degree between patients with low eGFR and those with normal eGFR (p > 0.05). Conclusion Successful PCI effectively improved symptoms and QOL of CTO patients with low eGFR.
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Affiliation(s)
- Shuai Zhao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Chen
- Department of Cardiology, No. 971 Hospital of the PLA Navy, Qingdao, Shandong, China
| | - Boda Zhu
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Primary Flight Training Base, Air Force Aviation University, Harbin, Heilongjiang, China
| | - Jiayi Wang
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhihong Wei
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yiming Zou
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wentao Hu
- Cadet Brigade, School of Basic Medicine, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Genrui Chen
- Department of Cardiology, Hanyin County People's Hospital, Ankang, Shaanxi, China
| | - Huan Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chenhai Xia
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tiantong Yu
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Peng Han
- Department of Cardiology, 981 Hospital of Joint Logistics Support Force, Chengde, Hebei, China
| | - Li Yang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Pharmaceutics and Pharmacy Administration, School of Pharmacy, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhongjie Zhai
- Department of Health Statistics, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haokao Gao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Haokao Gao
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,Chengxiang Li
| | - Kun Lian
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China,*Correspondence: Kun Lian ;
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Impact of impaired renal function on outcomes of chronic total occlusion undergoing revascularization: a systemic review and meta-analysis. Int Urol Nephrol 2022; 54:3179-3191. [PMID: 35689780 DOI: 10.1007/s11255-022-03192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients with chronic kidney disease (CKD) have an associated burden of coronary artery disease, including chronic total occlusions (CTO). It is unclear how the presence of CKD affects the outcomes of CTO revascularization. Previous reviews have not taken into account all relevant published studies that examined the association of CKD with outcomes of CTO revascularization. METHODS A systematic search was conducted using PubMed, Scopus, and Google Scholar databases for studies investigating patients with or without CKD who also had coronary chronic total occlusion undergoing revascularization procedures Statistical analysis was performed using STATA software. Effect sizes were reported as pooled relative risk (RR). RESULTS A total of 13 studies were included. CKD patients showed elevated risk of in-hospital mortality (RR 4.25, 95% CI 2.64, 6.82) and mortality at latest follow-up (RR 3.24, 95% CI 2.56, 4.11), elevated risk of major cardio or cerebrovascular events (RR 1.65, 95% CI 1.38, 1.98), major bleeding (RR 2.85, 95% CI 1.96, 4.13), and contrast-induced acute kidney injury (RR 3.06, 95% CI 1.70, 5.52). CKD patients also showed lower chances of technical success (RR 0.95, 95% CI 0.91, 1.00). CONCLUSIONS The presence of CKD increases the risk of mortality, complications and adversely affects the success of CTO revascularization. Patients with CKD undergoing revascularization should have their kidney function comprehensively evaluated and these patients should be carefully monitored.
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Impact of Chronic Kidney Disease on Chronic Total Occlusion Revascularization Outcomes: A Meta-Analysis. J Clin Med 2021; 10:jcm10030440. [PMID: 33498733 PMCID: PMC7865303 DOI: 10.3390/jcm10030440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To examine the impact of revascularization and associated clinical outcomes of chronic kidney disease (CKD) chronic total occlusion (CTO) and non-CKD CTO groups. Background: The influence of CKD on clinical outcomes after percutaneous coronary intervention (PCI) for CTO lesions is unknown, and there is no systemic review of this topic to date. Methods: We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials Databases for articles published between 1 January 2010 and 31 March 2020. CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease formula. Data included demographics, lesion distributions, incidence of contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural success rate, mortality, and target lesion revascularization (TLR)/target vessel revascularization (TVR). Results: Six studies were ultimately included in this systematic review. A high prevalence (25.5%; range, 19.6–37.9%) of CKD was noted in the CTO population. In the non-CKD group, outcomes were better: less incidence of CIN or AKI (odds ratio (OR), 2.860; 95% confidence interval (CI), 1.775–4.608), higher procedural success rate (OR, 1.382; 95% CI, 1.036–1.843), and lower long-term mortality (OR, 4.502; 95% CI, 3.561–5.693). The incidence of TLR/TVR (OR, 1.118; 95% CI, 0.888–1.407) did not differ between groups. Conclusions: In the CKD CTO PCI population, a lower procedural success rate, a higher incidence of CIN or AKI, and higher in-hospital and long-term mortality rate were noted due to more complex lesions and more comorbidities. However, the incidence of TLR/TVR did not differ between groups.
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Moroni F, Spangaro A, Carlino M, Baber U, Brilakis ES, Azzalini L. Impact of renal function on the immediate and long-term outcomes of percutaneous recanalization of coronary chronic total occlusions: A systematic review and meta-analysis. Int J Cardiol 2020; 317:200-206. [DOI: 10.1016/j.ijcard.2020.05.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
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Ortillon J, Hézard N, Belmokhtar K, Kawecki C, Terryn C, Fritz G, Kauskot A, Schmidt AM, Rieu P, Nguyen P, Maurice P, Touré F. Receptor for Advanced Glycation End Products is Involved in Platelet Hyperactivation and Arterial Thrombosis during Chronic Kidney Disease. Thromb Haemost 2020; 120:1300-1312. [PMID: 32726852 DOI: 10.1055/s-0040-1714101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with a high cardiovascular mortality due to increased rates of vascular lesions and thrombotic events, as well as serum accumulation of uremic toxins. A subgroup of these toxins (advanced glycation end products [AGEs] and S100 proteins) can interact with the receptor for AGEs (RAGE). In this study, we analyzed the impact of CKD on platelet function and arterial thrombosis, and the potential role of RAGE in this process. METHODS Twelve weeks after induction of CKD in mice, platelet function and time to complete carotid artery occlusion were analyzed in four groups of animals (sham-operated, CKD, apolipoprotein E [Apoe]-/-, and Apoe-/-/Ager-/- mice). RESULTS Analysis of platelet function from whole blood and platelet-rich plasma showed hyperactivation of platelets only in CKD Apoe-/- mice. There was no difference when experiments were done on washed platelets. However, preincubation of such platelets with AGEs or S100 proteins induced RAGE-mediated platelet hyperactivation. In vivo, CKD significantly reduced carotid occlusion times of Apoe-/- mice (9.2 ± 1.1 vs. 11.1 ± 0.6 minutes for sham, p < 0.01). In contrast, CKD had no effect on occlusion times in Apoe-/-/Ager-/- mice. Moreover, carotid occlusion in Apoe-/- CKD mice occurred significantly faster than in Apoe-/-/Ager-/- CKD mice (p < 0.0001). CONCLUSION Our results show that CKD induces platelet hyperactivation, accelerates thrombus formation in a murine model of arterial thrombosis, and that RAGE deletion has a protective role. We propose that RAGE ligands binding to RAGE is involved in CKD-induced arterial thrombosis.
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Affiliation(s)
- Jérémy Ortillon
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France
| | - Nathalie Hézard
- Hémostase et Remodelage Vasculaire Post-Ischémique, Laboratoire d'Hématologie, Faculté de Médecine & CHU Reims, Hôpital Robert Debré, Reims, France
| | - Karim Belmokhtar
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France
| | - Charlotte Kawecki
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France
| | - Christine Terryn
- PICT Platform, Université de Reims Champagne Ardenne, Reims, France
| | - Guenter Fritz
- Institute of Neuropathology, Neurozentrum, University of Freiburg, Freiburg, Germany
| | - Alexandre Kauskot
- HITh, UMR_S 1176, INSERM Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Ann Marie Schmidt
- Diabetes Research Program, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, New York University School of Medicine, New York, New York, United States
| | - Philippe Rieu
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France.,Division of Nephrology, CHU Reims, Reims, France
| | - Philippe Nguyen
- Hémostase et Remodelage Vasculaire Post-Ischémique, Laboratoire d'Hématologie, Faculté de Médecine & CHU Reims, Hôpital Robert Debré, Reims, France
| | - Pascal Maurice
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France
| | - Fatouma Touré
- UMR CNRS 7369 Matrice Extracellulaire et Dynamique Cellulaire (MEDyC), Team 2 "Matrix Aging and Vascular Remodelling," Université de Reims Champagne Ardenne, Reims, France.,Division of Nephrology, CHU Limoges, Limoges, France
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Malik AO, Spertus JA, Grantham JA, Peri-Okonny P, Gosch K, Sapontis J, Moses J, Lombardi W, Karmpaliotis D, Nicholson WJ, Al Badarin F, Salisbury AC. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Renal Dysfunction. Am J Cardiol 2020; 125:1046-1053. [PMID: 31955832 DOI: 10.1016/j.amjcard.2019.12.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
Although contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is performed with high success rates, 10% to 13% of patients presenting with CTOs have chronic kidney disease (CKD), and the comparative safety, efficacy, and health status benefit of CTO PCI in these patients, has not been well defined. We examined the association of baseline renal function with periprocedural major adverse cardiovascular and cerebral events and health status outcomes in 957 consecutive patients (mean age 65.3 ± 10.3 years, 19.4% women, 90.3% white, 23.6 CKD [estimated glomerular filtration rate {eGFR} < 60]) in the OPEN-CTO (Outcomes, Patients Health Status, and Efficiency in Chronic Total Occlusions Registry) study. Hierarchical multivariable regression models were used to examine the independent association of baseline eGFR with technical success, periprocedural complications and change in health status, using Seattle Angina Questionnaire (SAQ) over 1 year. Crude rates of acute kidney injury were higher (13.5% vs 4.4%, p <0.001) and technical success lower (81.8% vs 88.4%, p = 0.01) in patients with CKD. There were no significant differences in other periprocedural complications. After adjustment for confounding factors, there was no significant association of baseline eGFR with technical success or periprocedural major adverse cardiovascular and cerebral events (death, myocardial infarction, emergent bypass surgery, stroke, perforation), whereas patients with lower eGFR had higher rates of acute kidney injury. The difference in SAQ summary score, between patients on the 10th and 90th percentile for baseline eGFR distribution was not clinically significant (1 month: -0.91; 1 year: -3.06 points). In conclusion, CTO PCI success, complication rates, and the health status improvement after CTO PCI are similar in patients across a range of baseline eGFRs.
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Pillai AA, Ramasamy S, Jagadheesan KS, Satheesh S, Selvaraj RJ, Jayaraman B. Procedural and follow-up clinical outcomes after chronic total occlusion revascularization: Data from an Indian public hospital. Indian Heart J 2019; 71:65-73. [PMID: 31000185 PMCID: PMC6477135 DOI: 10.1016/j.ihj.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/03/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic total occlusion (CTO) continues to be challenging lesion subset for percutaneous intervention. Last decade has seen tremendous increase in percutaneous coronary intervention (PCI) in this subset owing to improved understanding of the anatomy and enhanced skillset with availability of dedicated hardware. We sought to study the outcomes of CTO PCI in an Indian public hospital. METHODS This was a single-center non-randomized descriptive follow-up study on CTO PCI. The end-points were procedural success, immediate, and late adverse cardiovascular events [major adverse cardiac event (MACE)] and change in angina and left ventricular function at follow-up. RESULTS A total 389 CTO lesions were treated with a success rate of 87% (339/389). The mean Japanese chronic total occlusion (J-CTO) score was 1.78 ± 0.12 (mean ± standard deviation). Multivariate analysis of different angiographic components of J-CTO score identified tortuosity (p = 0.001), calcifications (p ≤ 0.001), and blunt stump (p = 0.007) as independent predictors of procedural failure. The periprocedural mortality was less than 1%, and the non-life threatening complications were about 4%. The MACE rate was significantly higher in the procedural failure group (60%) than in the procedural success group (5.3%, p < 0.001). An increase in left ventricular ejection fraction (LVEF) was noted following successful CTO PCI after complete revascularization. CONCLUSIONS The success rates for CTO PCI in this registry were about 87%. Immediate and long-term clinical outcomes were better with lower MACE (5%) after a successful procedure. A key outcome variable included an increase in LVEF among patients after a successful CTO PCI. The overall periprocedural complications were about 5.5%, but majority were non-life threatening.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India.
| | - Sakthivel Ramasamy
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India
| | - Kabilan S Jagadheesan
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India
| | - Raja J Selvaraj
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India
| | - Balachander Jayaraman
- Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research(JIPMER), Puducherry, 605006, India
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